Francisco Gómez-Esquer

Introduction: Stroke accounts for one-third of global mortality each year; in Spain, it is the second leading cause of death. One of the most commonly reported complications is post-stroke depression, which affects up to 30% of patients who suffer a stroke. When an ischaemic stroke occurs, the treatment of choice is mechanical thrombectomy; this is an endovascular procedure whereby the thrombus causing the ischemia is removed, thereby reducing sequelae, in most cases, which is why it is of interest to examine its influence on the development of post-stroke depression. This study aims to determine the proportions of depressive symptoms in patients with ischaemic stroke who underwent mechanical thrombectomy as a treatment option, and to explore potential gender differences in depressive symptoms over time. Methods: This was a multicentre, observational, descriptive, longitudinal, and prospective study, with follow-up at two weeks, one month, three months, and six months after the event. Depressive symptoms were analysed longitudinally and compared according to gender. Results: Patients who suffered an ischaemic stroke and underwent mechanical thrombectomy had a depressive symptom proportions of 11% at 15 days, decreasing to 7% at 6 months. No significant gender differences were observed in the proportions or trajectory of depressive symptoms during follow-up. A total of 92% of the sample showed no change in quality of life. Conclusions: Patients undergoing endovascular intervention for ischemic stroke showed a low prevalence of subsequent depressive symptoms, with no significant differences observed by gender.

Cadaver‐based anatomy education represents a unique biological and sensory experience that may elicit significant physiological responses. However, little is known about the anticipatory phase prior to initial exposure, particularly when evaluated using objective biomarkers. This study aimed to assess anticipatory physiological responses in first‐year medical students before their initial cadaver exposure. Ninety students were evaluated using a within‐subject design comparing physiological measures obtained under standardized conditions at baseline (before a routine anatomy session without cadaver exposure) and immediately prior to their first entry into the dissection room (anticipatory condition), before any direct contact. Measures included systolic and diastolic blood pressure, heart rate, and salivary cortisol. Compared with baseline, the anticipatory phase was associated with significant increases in systolic blood pressure (116.9 ± 13.6 vs. 123.8 ± 13.4 mmHg, p < 0.001), heart rate (74.6 ± 13.1 vs. 82.9 ± 15.2 bpm, p < 0.001), and salivary cortisol levels (4.2 ± 2.1 vs. 5.3 ± 3.2 ng/mL, p < 0.001), indicating activation of both sympathetic and hypothalamic–pituitary–adrenal pathways. No significant changes were observed in diastolic blood pressure. These changes were associated with moderate effect sizes for systolic blood pressure ( d = 0.51), heart rate ( d = 0.58), and salivary cortisol ( d = 0.41). Physiological responses were not influenced by sex or sociocultural factors. These findings indicate that physiological stress activation is already present during the anticipatory phase preceding first cadaver exposure, supporting the existence of a distinct anticipatory component of cadaver‐based anatomy education characterized by coordinated autonomic and endocrine responses. This anticipatory phase represents a distinct physiological component of cadaver‐based anatomy education and provides objective evidence of biological activation occurring before first cadaver exposure. Recognizing this early physiological response may contribute to a better understanding of students' initial adaptation to cadaver‐based learning experiences.

Introduction: Fibromyalgia (FM) is a multifactorial syndrome involving chronic pain and psychological distress. Psychological traits such as anxiety, depression, and catastrophising are linked to symptom severity. Genetic variability may contribute to these dimensions through mechanisms related to pain modulation and stress response. Objectives: To examine associations between selected genetic polymorphisms and psychological variables in women with FM. Methods: A cross‐sectional study was conducted in 67 women diagnosed with FM. Pain intensity, FM impact and psychological variables—anxiety, depression and catastrophising—were assessed using validated questionnaires. Saliva samples were collected and 10 SNPs were genotyped ( COMT rs4680, DRD3 rs6280, OPRM1 rs1799971, BDNF rs6265, MAOA rs1137070, FKBP5 rs1360780, IL6 rs1800796, TNF rs1800629, IL10 rs1800896, IFITM3 rs12252). Correlations were assessed using Pearson or Spearman coefficients, and associations were examined using ANOVA or Kruskal–Wallis with Tukey or Mann–Whitney post hoc tests. Results: Pain intensity correlated with depression ( r = 0.476, p < 0.001), catastrophising ( r = 0.414, p < 0.001), and anxiety ( r = 0.314, p = 0.009). Catastrophising was related to depression ( r = 0.615, p < 0.001), anxiety ( r = 0.453, p < 0.001), and kinesiophobia ( r = 0.445, p < 0.001). BDNF rs6265 was associated with catastrophising ( p = 0.044), OPRM1 rs1799971 with anxiety ( p = 0.030), and MAOA rs1137070 with depression ( p = 0.020). Conclusions: Psychological variables in FM are interrelated and linked to pain perception. BDNF , OPRM1 and MAOA polymorphisms are associated with indices of psychological vulnerability, underscoring the importance of integrating genetic and psychological perspectives to understand variability in FM. Significance Statement: Genetic variability influences psychological vulnerability in fibromyalgia. Specific variants were associated with key psychological traits: BDNF rs6265 with pain catastrophising, OPRM1 rs1799971 with anxiety, and MAOA rs1137070 with depressive symptoms. These findings reveal an interplay between genetic and psychological factors that may guide more personalised strategies for managing fibromyalgia.

Background/Objectives: Fibromyalgia syndrome (FMS) is a multifactorial pain syndrome not only characterized by widespread pain as the primary symptom but also accompanied by physical, psychological, and cognitive manifestations. Impairments in conditioned pain modulation (CPM) are common in this population; however, there is significant heterogeneity in the CPM response among women with FMS. The Left/Right Judgment Task (LRJT) is a validated method for studying motor imagery in chronic pain patients. Previous scientific evidence has not yet thoroughly investigated the relationship between CPM alterations and motor imagery processes in FMS patients. The aim of this study was to investigate the relationship between CPM and motor imagery. Methods: This is a secondary analysis of a cross-sectional study. Pain intensity (NPRS), disability (FIQ), mechanical hyperalgesia (PPT), descending pain modulation (CPM), and laterality discrimination (LRJT) were assessed in 30 women diagnosed with FMS. Participants were divided into two groups, responder and non-responder, according to their response to the CPM test. Results: Findings showed that the FMS subgroup of non-responders to CPM, performed worse in motor imagery processes (LRJT). Additionally, older age and higher mechanical hyperalgesia were also associated with poorer functioning of the inhibitory system. Conclusions: Women with FMS who are non-responders to CPM exhibit a reduced ability to perform motor imagery processes. Additionally, the non-responder group shown significant differences, such as older age and greater initial mechanical hyperalgesia compared to the responder group.

Background/Objectives: Fibromyalgia (FM) is a syndrome characterized by widespread chronic pain as the primary symptom. Neurophysiological pain mechanisms, such as the function of the descending inhibitory system, are impaired in this condition. The main objective of this study was to compare the results of two paradigms to evaluate CPM in women with FM. The secondary objective was to correlate the results of each CPM paradigm with the clinical status of patients with FM. Methods: One hundred and three FM women were divided into two groups: fifty patients diagnosed with FM were assigned to the conditioned pain modulation (CPM) group using a cold pressor stimulus, and fifty-three patients were assigned to the CPM group using the ischemic pressure stimulus. The main outcome measures were pain intensity, disability, mechanical hyperalgesia, and CPM. Results: The primary analysis revealed significant differences between the results obtained from the different CPM protocols. Poorer outcomes in the cold pressor test correlated with higher pain intensity and a greater disability index. Conclusions: Pain modulation abnormalities in FM patients were evident when using either the cold pressor or ischemic pressure stimuli to establish the CPM paradigm. The cold pressor conditioning stimulus elicited a stronger response than the ischemic pressure stimulus in FM patients.

Fibromyalgia (FM) is a chronic pain syndrome hypothesized to arise from a state of neurogenic inflammation. Mechanisms responsible for pain, as well as psychological variables, are typically altered in this condition. The main objective of this research was to explore somatosensory and psychological alterations in women with FM. The secondary objective was to carry out a secondary analysis to correlate the different variables studied and delve into the influences between them. The relationship between different psychological variables in fibromyalgia is not clear in the previous scientific literature. Forty-four individuals participated, of which twenty-two were controls and twenty-two were women with fibromyalgia. The main outcome measures were the Numeric Pain Rating Scale, Fibromyalgia Impact Questionnaire, pressure pain threshold, conditioned pain modulation, anxiety and depression symptoms, catastrophizing and kinesiophobia cognitions. The main analysis showed that there is a moderate correlation between the psychological variables of depression and fear of movement and the ability to modulate pain. There is also a moderately inverse correlation between pain catastrophizing cognitions and pain intensity/disability. Multiple moderate and strong correlations were found among the various psychological variables studied. FM patients exhibit somatosensory alterations alongside negative psychological symptoms that influence the experience of pain, and they may perpetuate the state of neurogenic inflammation.

The role of genetics as a predisposing factor related to an increased risk of developing long COVID symptomatology is under debate. The aim of the current secondary analysis was to identify the association between the Apolipoprotein E (ApoE) gene, a gene affecting cholesterol metabolism and previously associated with a higher risk of SARS-CoV-2 infection and COVID-19 severity, and the development of long COVID in a cohort of individuals who had been hospitalized by SARS-CoV-2 infection. Unstimulated whole saliva samples were collected from 287 previously hospitalized COVID-19 survivors. Three genotypes of the ApoE gene (ApoE ε2, ε3, ε4) were obtained based on the combination of ApoE rs429358 and ApoE rs7412 polymorphisms. Participants were asked to self-report the presence of any post-COVID symptom in a face-to-face interview at 17.8 ± 5.2 months after hospital discharge and medical records were obtained. Each participant reported 3.0 (1.9) post-COVID symptoms. Overall, no significant differences in long COVID symptoms were observed depending on the ApoE genotype (ApoE ε2, ApoE ε3, ApoE ε4). The presence of the ApoE ε4 genotype, albeit associated with a higher risk of SARS-CoV-2 infection and COVID-19 severity, did not appear to predispose for the presence of long COVID in our cohort of previously hospitalized COVID-19 survivors.

Previous scientific evidence has shown that patients with fibromyalgia syndrome (FMS) have alterations in the body schema. There have also been findings regarding the influence of psychological factors on pain, as well as evidence that patients with FMS have difficulty performing laterality discrimination tasks. The main objective of this study was to evaluate whether emotional and cognitive factors influence the limb laterality discrimination task in women with FMS. Seventeen of the participants were healthy female controls, and the other seventeen were women diagnosed with FMS. The main outcome measures were laterality discrimination, anxiety symptoms, depression symptoms, pain catastrophizing, and fear-related movement. The main analysis showed that patients with FMS had longer reaction times for laterality discrimination in hands (hand 20 images, p < 0.031; hands 50 images p < 0.013). In the secondary analysis, FMS patients showed emotional (anxiety (p < 0.0001); depression (p < 0.0001)) and cognitive (pain catastrophizing (p < 0.0001); fear-related movement (p < 0.0001)) disorders compared with healthy subjects. There was no correlation between limb laterality discrimination and psychological variables. In conclusion, patients with FMS showed impaired laterality discrimination, but psychological variables were not influenced. This could be due to the implicit nature of the task.

The aim of the study was to identify the association between four selected COVID-19 polymorphisms of ACE2 and TMPRSS2 receptors genes with the presence of long-COVID symptomatology in COVID-19 survivors. These genes were selected as they associate with the entry of the SARS-CoV-2 virus into the cells, so polymorphisms could be important for the prognoses of long-COVID symptoms. Two hundred and ninety-three (n = 293, 49.5% female, mean age: 55.6 ± 12.9 years) individuals who had been previously hospitalized due to COVID-19 were included. Three potential genotypes of the following single nucleotide polymorphisms (SNPs) were obtained from non-stimulated saliva samples of participants: ACE2 (rs2285666), ACE2 (rs2074192), TMPRSS2 (rs12329760), TMPRSS2 (rs2070788). Participants were asked to self-report the presence of any post-COVID defined as a symptom that started no later than one month after SARS-CoV-2 acute infection and whether the symptom persisted at the time of the study. At the time of the study (mean: 17.8, SD: 5.2 months after hospital discharge), 87.7% patients reported at least one symptom. Fatigue (62.8%), pain (39.9%) or memory loss (32.1%) were the most prevalent post-COVID symptoms. Overall, no differences in long-COVID symptoms were dependent on ACE2 rs2285666, ACE2 rs2074192, TMPRSS2 rs12329760, or TMPRSS2 rs2070788 genotypes. The four SNPs assessed, albeit previously associated with COVID-19 severity, do not predispose for developing long-COVID symptoms in people who were previously hospitalized due to COVID-19 during the first wave of the pandemic.